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General NPI Number Information
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NPI Number | 1750414132
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Entity Type | Organization
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Legal Business Name | MECKLENBURG OPEN DOOR, INC.
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3711 CARMEL FOREST DR
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City | CHARLOTTE
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State | NC
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Zip | 28226-8117
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Country | US
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Telephone | 704-542-8727
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Fax | 704-542-9198
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Provider Business Mailing Address
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Address Line | 1515 MOCKINGBIRD LN SUITE 1015
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City | CHARLOTTE
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State | NC
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Zip | 28209-3236
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Country | US
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Telephone | 704-525-3255
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Fax | 704-525-0949
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. EDWARD G PAYTON
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Credential |
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Telephone | 704-525-3255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MHL-060-248
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License Number State | NC
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